Chen X, Zhu L
Department of emergency, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Zhonghua Yi Xue Za Zhi. 2021 Jan 19;101(3):218-223. doi: 10.3760/cma.j.cn112137-20200509-01471.
To investigate the prognostic factors of severe traumatic brain injury (sTBI) and the predictive value of serum translocator protein (TSPO) combined with the reverse shock index multiplied by Glasgow coma scale score (rSIG). A total of 104 patients with sTBI treated in the Third Affiliated Hospital of Soochow University from June 2017 to June 2019 were enrolled and divided into two groups according to their 90-day prognosis evaluated by Glasgow prognosis score (GOS): 61 cases in good prognosis group, including 42 males and 19 females, the average age was (52.6±4.1) years; 43 cases in poor prognosis group, including 32 males and 11 females, the average age was (53.2±4.4) years. The clinical data, rSIG and serum TSPO levels were compared between the two groups. The prognostic factors were analyzed by the univariate analysis and logistic regression model, and the predictive value of rSIG combined with serum TSPO was evaluated by the receiver operating characteristic curve (ROC). The time from injury to recovery, dilated pupils on admission, blood glucose level, serum TSPO level, CT midline shift ≥5 mm, cerebral herniation and postoperative complications were independent risk factors associated with the prognosis of sTBI patients, while the rSIG was protective factor associated with the prognosis of sTBI patients (all <0.05). The average value of rSIG in the good prognosis group was significantly higher than that in the poor prognosis group (11.6±3.2 vs 6.6±2.0, =9.021, <0.05). The average serum level of TSPO in the good prognosis group was lower than that in the poor prognosis group ((1.3±0.3) vs (3.1±1.1) μg/L, =12.350, <0.05). The area under the curve (AUC) of the combination of rSIG value and TSPO level for predicting the poor prognosis of sTBI patients was 0.920 (95%: 0.808-0.978), which was significantly higher than that of rSIG or TSPO alone (both <0.05). The overall sensitivity and the specificity of the combination were 80.0% and 92.0%, respectively. The rSIG value and serum TSPO level was significantly negatively correlated in sTBI patients (=-0.439, <0.05). sTBI patients who show a low rSIG value and high expression of serum TSPO tend to have bad prognosis. The combined application of rSIG and serum TSPO can effectively predict the poor prognosis in sTBI patients.
探讨重型颅脑损伤（sTBI）的预后因素及血清转位蛋白（TSPO）联合反向休克指数乘以格拉斯哥昏迷量表评分（rSIG）的预测价值。选取2017年6月至2019年6月在苏州大学附属第三医院治疗的104例sTBI患者，根据格拉斯哥预后评分（GOS）评估的90天预后分为两组：预后良好组61例，其中男性42例，女性19例，平均年龄（52.6±4.1）岁；预后不良组43例，其中男性32例，女性11例，平均年龄（53.2±4.4）岁。比较两组的临床资料、rSIG及血清TSPO水平。采用单因素分析和逻辑回归模型分析预后因素，通过受试者工作特征曲线（ROC）评估rSIG联合血清TSPO的预测价值。受伤至恢复时间、入院时瞳孔散大、血糖水平、血清TSPO水平、CT中线移位≥5 mm、脑疝及术后并发症是sTBI患者预后的独立危险因素，而rSIG是sTBI患者预后的保护因素（均P<0.05）。预后良好组rSIG平均值显著高于预后不良组（11.6±3.2 vs 6.6±2.0，t=9.021，P<0.05）。预后良好组血清TSPO平均水平低于预后不良组（（1.3±0.3） vs （3.1±1.1）μg/L，t=12.350，P<0.05）。rSIG值与TSPO水平联合预测sTBI患者预后不良的曲线下面积（AUC）为0.920（95%CI：0.808-0.978），显著高于单独的rSIG或TSPO（均P<0.05）。联合检测的总体敏感度和特异度分别为80.0%和92.0%。sTBI患者中rSIG值与血清TSPO水平呈显著负相关（r=-0.439，P<0.05）。rSIG值低且血清TSPO高表达的sTBI患者预后往往较差。rSIG与血清TSPO联合应用可有效预测sTBI患者的不良预后。
